Provider Demographics
NPI:1083614135
Name:SHIN, DAVID DONGRYUN (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:DONGRYUN
Last Name:SHIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6550 FANNIN ST
Mailing Address - Street 2:STE 2407
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2748
Mailing Address - Country:US
Mailing Address - Phone:713-790-5227
Mailing Address - Fax:713-790-5505
Practice Address - Street 1:6550 FANNIN ST STE 2407
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2748
Practice Address - Country:US
Practice Address - Phone:713-790-0000
Practice Address - Fax:713-790-1212
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK63232086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8199K1OtherBCBS
TX102117202Medicaid
TX102117202Medicaid
G76525Medicare UPIN